Physician Shortage, Lack of Regulation, Education Make Launching Male Circumcision Programs in Africa Difficult, Wall Street Journal Reports
September 7, 2007
A physician shortage, lack of medical regulation and low education levels are making it difficult to implement safe male circumcision programs in Africa in an effort to curb the spread of HIV, the Wall Street Journal reports (Schoofs, Wall Street Journal, 9/7). According to final data from two NIH-funded studies -- conducted in Uganda and Kenya and published in the Feb. 23 issue of the journal Lancet -- routine male circumcision could reduce a man's risk of HIV infection through heterosexual sex by 65%. The results of the Uganda and Kenya studies mirrored similar results of a study conducted in South Africa in 2005. In response to the findings, the World Health Organization and UNAIDS in March recommended the procedure as a way to help reduce transmission of the virus through heterosexual sex (Kaiser Daily HIV/AIDS Report, 8/10).
Some health workers in Africa lack adequate equipment to perform safe circumcision, such as scissors sharp enough to not leave ragged edges. Many ritual circumcisers often perform the procedure without sterilization or bandages, and because the penis is rich in blood vessels, excessive bleeding and infection can occur if the vessels are not tied properly. In addition, lignocaine, a local anesthetic commonly used in Kenya, can cause irregular heartbeat and cardiac arrest if injected into the bloodstream rather than into tissue. Many Kenyans with little education do not understand the difference between ritual healers and doctors, the Journal reports.
According to the Journal, some social advocates in Kenya are urging parents to have their sons circumcised in medical rather than ritual settings. In addition, increased education in the country has spread knowledge about sanitary medical procedures. Some Christian churches in the country have begun to offer safe, medical circumcisions in their communities.
Peter Cherutich, a member of the Kenyan Ministry of Health's circumcision task force, said he hopes the government will begin to offer no-cost circumcisions. The government is seeking support from donor governments and international organizations to fund such a program, the Journal reports (Wall Street Journal, 9/7). The President's Emergency Plan for AIDS Relief last month announced it would begin providing money for male circumcision programs in some African countries in an effort to reduce the spread of HIV. PEPFAR focus countries have been invited to request program funding to increase access to the procedure (Kaiser Daily HIV/AIDS Report, 8/20).
According to Cherutich, the health ministry's circumcision task force will consider training nurses to perform the procedure to help address the shortage of physicians available to provide circumcisions. However, he added that it might not help solve the problem because the majority of nurses in Kenya are women, and many traditional cultures object to women performing the procedure. Cherutich said that increased access to safe circumcision could "make a huge difference in the HIV epidemic" (Wall Street Journal, 9/7).
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This article was provided by Henry J. Kaiser Family Foundation. It is a part of the publication Kaiser Daily HIV/AIDS Report. Visit the Kaiser Family Foundation's website to find out more about their activities, publications and services.